The efficacy and toxicity of chemotherapy in the elderly with advanced pancreatic cancer

Li, Xiang; Huang, Dabing; Zhang, Qi; Guo, Chengxiang; Fu, Qihan; Zhang, Xiaochen; Tang, Tianyu; Su, Wei; Chen, Yiwen; Chen, Wei; Ma, Tao; Gao, Shunliang; Que, Risheng; Bai, Xueli

doi:10.1016/j.pan.2019.11.012

Cited by 33 publications

(32 citation statements)

References 22 publications

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“… 16 Another study conducted in China showed that age (<70 vs. ≥70 years) did not affect treatment outcomes but older adults were more likely to experience adverse events highlighting the importance of patient selection to inform treatment decisions. 19 …”

Section: Discussionmentioning

confidence: 99%

Real-world Impact of Age at Diagnosis on Treatment Patterns and Survival Outcomes of Patients with Metastatic Pancreatic Ductal Adenocarcinoma

Elias

Cockrum

Surinach³

et al. 2022

The Oncologist

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Background Sixty-eight percent of patients with pancreatic ductal adenocarcinoma (PDAC) are 65 years and older. Older adults are under-represented in clinical trials and their care is complicated with multiple age-related conditions. Research suggests that older patients can experience meaningful responses to treatment for PDAC. The objective of this study was to evaluate the characteristics, rate of treatment, and survival outcomes of patients with metastatic PDAC (mPDAC) based on age at diagnosis. Materials and Methods Data were extracted for patients diagnosed with mPDAC between January 1, 2015, and March 31, 2020, from the Flatiron Health database. Patients were stratified into 3 age groups: <70 years old, 70-79 years, and ≥80 years. The proportion of patients who received first-line therapy, the types of regimens received in the metastatic setting, overall survival (OS) from the start of treatment were evaluated. Results Of the 8382 patients included, 71.3% (n = 5973) received treatment. Among patients who received treatment 55.5% (n = 3313) were aged <70 years at diagnosis, 33.0% (n = 1972) were 70-79 years, and 11.5% (n = 688) were ≥80 years. Patients ≥80 years of age were more likely to receive gemcitabine monotherapy and less likely to receive FOLFIRINOX. Among first-line treated patients, median OS significantly decreased with age. However, when comparing patients treated with the same first-line regimen, no significant differences in median OS were observed by age. Conclusions This study highlights that older adults with mPDAC can benefit substantially by receiving appropriate levels of treatment.

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Section: Discussionmentioning

confidence: 99%

Real-world Impact of Age at Diagnosis on Treatment Patterns and Survival Outcomes of Patients with Metastatic Pancreatic Ductal Adenocarcinoma

Elias

Cockrum

Surinach³

et al. 2022

The Oncologist

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“…21 Both FOFIRINOX and AG regimens are internationally recognized first-line chemotherapy regimens for advanced pancreatic cancer. 22 In consideration of the large side effects of chemotherapy regimen with FOLFIRINOX, which are often difficult to be tolerated by patients, we chose the AG regimen in this study. Previous studies have shown that the combination of immunotherapy and chemotherapy has achieved better results than chemotherapy alone in the treatment of various solid tumors.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of PD-1 Inhibitors Combined with Nab-Paclitaxel Plus Gemcitabine versus Nab-Paclitaxel Plus Gemcitabine in the First-Line Treatment of Advanced Pancreatic Cancer: A Retrospective Monocentric Study

Zhang¹,

Wang²,

Yang³

et al. 2022

CMAR

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The purpose of this study was to evaluate the efficacy and safety of PD-1 inhibitor combined with nab-paclitaxel plus gemcitabine (AG) chemotherapy versus AG chemotherapy in the first-line treatment of advanced pancreatic cancer. Patients and Methods: This study included the application of AG treatment and PD-1 combined with AG treatment with advanced pancreatic ductal adenocarcinoma at the Affiliated Hospital of Qingdao University from September 2018 to July 2020. Clinical information and next-generation sequencing (NGS) reports of patients were collected to compare the effectiveness and adverse events of the two treatments and analyze the risk factors affecting the prognosis of patients. Results: There was no difference in PFS between the AG group and the PD-1+AG group (4.9 months vs 5.0 months, P = 0.154), but the difference in OS was statistically significant (9.3 months vs 12.1 months, P < 0.001). Compared with the AG group, the PD-1+AG group reduced the risk of death about 20.0% (HR = 0.203, 95% CI, 0.090−0.459, P < 0.001). In terms of safety, the incidence of hypothyroidism and reactive skin capillary hyperplasia in PD-1 + AG group was higher than that in AG group (P < 0.050) in grade 1-2; grade 3-4 adverse reactions were mainly hematologic AEs and abnormal liver function. The incidence of grade 3-4 adverse reactions in the two groups was 38.7% (95% CI, 20.5-56.9%) and 35.3% (95% CI, 10.0-60.6%), respectively. In addition, PD-1+ AG regimen improved the OS of patients with KRAS and TP53 co-mutations (8.0months vs 10.2 months, P = 0.004). Conclusion: PD-1 inhibitors combined with AG chemotherapy have shown good efficacy and safety in the first-line treatment of patients with advanced pancreatic ductal adenocarcinoma. This regimen similarly improved OS in patients with KRAS and TP53 comutations.

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“…The response rates, the OS, and PFS were comparable for patients <70 years and >70 years. However, the incidence of severe adverse events was higher in elderly patients (50% vs. 28.3%) [56]. In another retrospective analysis, the patients who received FOLFIRINOX were, on average, five years younger than those who received other chemotherapy (FOLFOX or gemcitabine).…”

Section: Treatment Options In Elderly Patientsmentioning

confidence: 95%

Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward

Franck

Müller

Rosania

et al. 2020

Cancers

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Globally, the death rate of pancreatic ductal adenocarcinoma (PDAC) has doubled over 30 years and is likely to further increase, making PDAC a leading cause of cancer-related death in the coming years. PDAC is typically diagnosed at an advanced stage, and modified FOLFIRINOX or nab-paclitaxel and gemcitabine are the mainstay of systemic therapy. For elderly patients with good performance status, low-dose treatment can preserve quality of life without compromising cancer control or survival. Maintenance therapy should be considered in PDAC patients achieving disease control with systemic therapy. In particular, olaparib has demonstrated a progression-free survival benefit of 3.6 months in a subgroup of PDAC patients with germline BRCA1/2 mutations (ca. 10% of all PDAC). Pancreatic enzyme replacement therapy is often omitted in the treatment of patients with PDAC, with possibly deleterious consequences. Small intestinal bacterial overgrowth is highly prevalent in patients with PDAC and should be considered in the diagnostic algorithm of PDAC patients with bloating and diarrhea. Rivaroxaban has been associated with a reduced risk of thrombosis without an increase in major bleeding events, and its use should be considered in every patient with advanced PDAC undergoing systemic therapy.

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The efficacy and toxicity of chemotherapy in the elderly with advanced pancreatic cancer

Cited by 33 publications

References 22 publications

Real-world Impact of Age at Diagnosis on Treatment Patterns and Survival Outcomes of Patients with Metastatic Pancreatic Ductal Adenocarcinoma

Real-world Impact of Age at Diagnosis on Treatment Patterns and Survival Outcomes of Patients with Metastatic Pancreatic Ductal Adenocarcinoma

The Efficacy and Safety of PD-1 Inhibitors Combined with Nab-Paclitaxel Plus Gemcitabine versus Nab-Paclitaxel Plus Gemcitabine in the First-Line Treatment of Advanced Pancreatic Cancer: A Retrospective Monocentric Study

Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward

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